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HealthSpring TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring TotalCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring TotalCare (HMO D-SNP) in 2026, please refer to our full plan details page.
HealthSpring TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring TotalCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSpring TotalCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSpring TotalCare (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HealthSpring TotalCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HealthSpring TotalCare (HMO D-SNP) Medicare prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail order service. If you use standard pharmacies or standard mail order, Tier 1 copays range from $5 to $15 and Tier 2 copays range from $10 to $30 depending on the supply duration. For brand-name and specialty medications, your costs are determined by coinsurance. Tier 3 preferred brand drugs carry a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail order types. Specialty tier prescriptions are limited to a one-month supply under this plan.
Additional Benefits
HealthSpring TotalCare (HMO D-SNP) offers robust coverage with no copays or coinsurance for many essential services, including inpatient hospital stays, primary and specialist visits, and preventive care. Outpatient services, home health care, and laboratory tests are also covered with no copays, helping to keep your medical expenses minimal. For other specialized medical needs, the plan features low cost-sharing, such as a 15% coinsurance for dialysis and predictable daily copays for skilled nursing facilities. Beyond medical care, this plan provides valuable extra benefits including comprehensive dental coverage up to a $3,000 annual limit and a $300 yearly eyewear allowance with no copays. Members also benefit from unlimited transportation to plan-approved locations and a $200 allowance every three months for over-the-counter items at no cost. Routine hearing exams are covered with no copay, while prescription hearing aids are offered with flat copayments.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) covers inpatient acute hospital stays with no copay, no coinsurance, and unlimited days, while psychiatric stays have no coinsurance but require a $320 daily copay for days 1 through 5 and no copay for days 6 through 90. Certain services, including non-Medicare-covered stays, room upgrades, and additional psychiatric days, are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, and blood services, with no copay and no coinsurance. Outpatient substance abuse services are also covered with no copay, but individual and group sessions are subject to a 20% coinsurance.
Partial Hospitalization See details
HealthSpring TotalCare (HMO D-SNP) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HealthSpring TotalCare (HMO D-SNP) covers ground ambulance services with a $100 copay and air ambulance services with a 20% coinsurance. Transportation services are partially covered, offering unlimited rides to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist, occupational and physical therapy, and telehealth services with no copay and no coinsurance, while opioid treatment is covered with no copay and 20% coinsurance. Podiatry is not covered, and while some chiropractic, mental health, and psychiatric services are covered, routine and other chiropractic care, as well as individual and group therapy sessions, are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes training. Additional preventive benefits are partially covered; fitness programs and caregiver support are included, but health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) hearing services are partially covered with no deductible, offering annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids require a $399 to $1,800 copay with no coinsurance—excluding inner ear, outer ear, and over the ear types—while OTC hearing aids have a $399 copay with no coinsurance.
Vision Services See details
Vision services under HealthSpring TotalCare (HMO D-SNP) are covered with no copay, no coinsurance, and no deductible, though eye exams are partially covered because other eye exam services are not covered. The plan provides no-cost coverage for one routine eye exam per year and up to $300 annually for eyewear, including contact lenses, upgrades, and one pair of eyeglasses.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers a wide range of preventive, comprehensive, and orthodontic dental services with no copay and no coinsurance up to a maximum annual benefit of $3,000. Medicare-covered dental services are also covered with no copay and no coinsurance, though prior authorization is required.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare (HMO D-SNP) covers Dialysis Services with no copay and a 15% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, and prosthetic devices and medical supplies with no copay and a 10% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers diagnostic services, offering covered lab services with no copay and no coinsurance, while requiring prior authorization and referrals. Diagnostic procedures, tests, and all radiological services, including X-rays, are not covered.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare (HMO D-SNP) provides coverage for Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization and referral requirements. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers other services, offering a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $200 every three months for OTC items, and a limited-duration meal benefit is provided for qualifying medical conditions or chronic illnesses.
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